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Office of Public and Intergovernmental Affairs

Remarks by Former Deputy Secretary W. Scott Gould

VA Research and Development Week
Washington, DC
April 22, 2010

Welcome everyone.

I am delighted to be here this morning to help kick off Research Forum 2010— celebrating 85 years of Discovery, Innovation, and Advancement. The video we just watched eloquently depicts the incredible work that our R&D teams and Veteran Volunteers accomplish every day, and I congratulate Dr. Kupersmith and his team for producing such a compelling story of R&D’s role in caring for our nation’s Veterans. Frankly, this is a video that should go viral on YouTube. We need to share these stories with the rest of the nation and the world.

It is an honor to share this room with such a brain trust of research excellence. I am reminded of a quote of President Kennedy’s: “This is the most extraordinary collection of talent, of human knowledge, that has ever been gathered together, with the possible exception of when Thomas Jefferson dined alone.”

At this forum is a constellation of research stars whose work has illuminated the darkest corners of human suffering; has cast a bright light onto the stages of countless microscopes; and has revealed the pathways for some of medical science’s greatest achievements.

From Dr. Norenberg’s work in neuropathology and spinal cord injury therapies, to Dr. Weinman’s contributions to a better understanding of kidney functions; from Dr. Duckworth’s focus on insulin action, to Dr. Cushman’s studies of hypertension; from Dr. Kibbe’s groundbreaking work on nitric-oxide and vascular research, to Dr. Sox-Harris’s examination of addiction treatment; and from Dr. Goldstein’s development of ATHENA DSS, to Dr. Ruff’s leadership in stroke rehabilitation and TBI. The VA researchers we celebrate today embody the myriad questions, investigations, and discoveries arcing across the 85-year-wide landscape of Veterans healthcare.

I will be the first one to admit that most of what I just commended our researchers for is over my head; but then, VA medical research has a history of being over all our heads, literally.

On April 5th, the Space Shuttle carried to the International Space Station an experiment that may well have a major impact on the human immune system’s ability to help our aging Veterans fight off infections.

Perhaps I’d best let the words of the experiment’s designer, Dr. Millie Hughes-Fulford describe the mission’s goal: “Lowered resistance to infection is common in both the elderly and in astronauts. In both cases, the T-cell is thought to be key in fighting disease. This experiment on the International Space Station offers us a chance to look for new approaches in treating immunosuppression here on earth.”

Who better among VA’s cadre of researchers to understand the link between space flight and earth-bound Veterans’ health than Dr. Hughes-Fulford, Director of the Laboratory for Cell Growth at the San Francisco VA Medical Center, and a scientist-astronaut who flew on the Space Shuttle in 1991?

And though Dr. Hughes-Fulford’s T-cell experiment might be out-of-this-world, the work of all our VA researchers achieves new heights in healthcare every day, and is heralded in the most respected journals and honored on award stages from here to Stockholm—where VA’s own Dr. Andrew Schally and Dr. Rosalyn Yalow received the Nobel Prize in Physiology in 1977.

Almost daily, VA’s research advances are making news, like the exciting paper on robot-delivered stroke rehabilitation published last week in the New England Journal of Medicine. The study’s chairman, Dr. Albert Lo, a neurologist at the Providence VA Medical Center, said, “There are nearly six million stroke patients in the U.S. with chronic loss of function. We’ve shown that with the right therapy, patients can see improvements in movement, everyday function and quality of life.” How could that not send positive waves of hope to stroke victims and their families everywhere?

From a very personal perspective, I have great hopes for the future of VA R&D outcomes for aging Veterans, not only in the search for immunosuppressive and stroke breakthroughs, but for a breakthrough in the diagnosis and treatment of Alzheimer’s—a disease that took the life of my father, a World War II and Korean War Veteran. My father was part of a VA-led Alzheimer’s study and was the longest-living member of his cohort when he died after 11 years of care in a VA facility.
I believe that if any healthcare system has the ability to fund and encourage its researchers to aggressively, and successfully, pursue the root cause of, and develop treatments for, Alzheimer’s before it becomes a killer, it is VA R&D teams and our research partners from the Alzheimer’s Association. They have a sense of purpose that stems from the mind and the heart. They are on the frontline of that battle, and I believe they will prevail.

The rising tide of research lifts the prospects of better health for all Veterans—from the aging warriors of the Greatest Generation, to the youngest soldiers of the latest generation.
In Secretary Shinseki’s words, “As we seek to transform VA, three fundamental attributes mark the starting point for framing a 21st century organization: people-centric, results-driven, and forward-looking; these attributes require continued and increased emphasis on discovery, innovation, and best-practices.”
Through R&D’s main research services—Biomedical Laboratory, Clinical Sciences, Health Services, and Rehabilitation—you are demonstrating every day that healthcare is both an art and a science, each complementing the other to consistently deliver the right care, at the right place, at the right time. Because clinical care and research occur together under one roof, VA brings scientific discovery from the patient’s bedside to the laboratory and back, making this program one of VA’s most effective tools for improving the care of Veterans. VA will continue to play a leading role in the advancement of clinical medical knowledge.

I encourage the R&D community to think about your work within the VA mission and our strategy. We have the budget—more than $1 billion for FY 2010 and FY 2011 combined—to advance the mission as never before; let’s use it wisely. These research funds will help VA sustain its long track record of success in conducting research projects that lead to clinically useful interventions that improve the health and quality of life for Veterans as well as the general population. The funding will also allow us to continue our aggressive research program aimed at improving the lives of Veterans returning from service in Iraq and Afghanistan.

A little later this morning, you will have the opportunity to hear from—in more ways the one—Mr. Stephan Cochran, an Iraq and Afghanistan Veteran whose back was broken in Afghanistan when an IED exploded next to him, leaving him paralyzed and unable to walk. Not all that long ago, such an injury would have only one outcome—a lifetime in a wheelchair.
But, Mr. Cochran did not accept that future, nor was that future acceptable to the doctors at the Nashville Veterans Medical Center who performed an experimental procedure that had life-altering, and re-affirming, results for Mr. Cochran.
Keeping Mr. Cochran’s example in mind—and with his song, “Hope,” still in your ears—I encourage you to think about our $1 billion-plus as a portfolio of possibilities, to create opportunities, to advance our R&D mission, while strengthening VA’s capacity to care for more Veterans like Mr. Cochran.

You are already seizing the opportunities to expand on our prevention, treatment, and rehabilitation research, including polytrauma, burn injury research, pain research, and TBI and post-deployment mental health research. I want to thank Ms. Lee Woodruff for the work she and her husband, Bob, have undertaken on behalf of wounded Veterans who require long-term care after sustaining traumatic injuries during their service. Few civilians know as well as the Woodruffs do the effect traumatic brain injury has on a soldier and his or her family.
With all our successes for Veterans health care—those breakthroughs we’ve achieved and those yet to come—we also recognize that the VA health system is not separate from the nation’s health care system; it is an integral part of it. Our system influences, and is affected by, the nation’s system. But there is more to it than that.
What we do in VA R&D extends far beyond the walls of our research centers and hospitals. The breakthroughs in medical technology, in patient safety, in new medicines, in long-distance care, reach around the globe. The CT scanner, a VA-research inspired diagnostic tool, is internationally ubiquitous.

Our work with injured Veterans returning from Iraq and Afghanistan—whose wounds are both seen and unseen—is making a huge difference not only in their quality of life, but in the quality of lives of countless others—America’s Veterans and the global community’s citizens—who will benefit from our R&D in TBI, spinal-cord-injury, PTSD, diabetes, heart disease, and other physical and mental health conditions.

It is important to see VA R&D as part of a broader system of innovation. Not only scientific and clinical insights, but also through people, processes, and technology; not only long-term, but in the shorter-term using historical information and by creating on-ramps for new procedures and technology to pilot and prototype improvements; not only what medicine needs to advance practically for mankind, but to do what Veterans may need and no one else will do, like Agent Orange, Gulf War, and hexavalent chromium. We must match our principles, and complement other government and private-sector investments. And we must embrace positive influence and insight from other disciplines and treatments like those in integrative medicine.
At VA as a whole, we know we cannot rest on our laurels—as comforting as they may be. We must constantly press forward in our quest for excellence, or we, like all organizations, will risk irrelevance, an example of the failure to anticipate. Maintaining VA status quo in a changing and demanding environment equates to failure to recognize and plan for the future.

We cannot afford the consequences of inaction—we must seize the opportunity to lead change in healthcare to the benefit of Veterans, the country, and the world. For example, our current model is utilization-driven; but the assumption that more care is better care isn’t valid. More utilization doesn’t equate to quality or better outcomes; it does lead to higher costs. To improve quality and access, while controlling costs, we must design a healthcare system that drives and measures quality and access outcomes—not utilization.

Our goal is to optimize, not maximize healthcare for Veterans, so we can responsibly use public resources. We need to bend the knee of the cost curve—to achieve the best balance between quality and good stewardship of the taxpayer’s dollars;
The old system, and much of what still passes for new, is based on a traditional model of delivery and utilization that are not in line with the needs of Veterans today. We must get to the heart of the matter—reduce the variances, focus on the quality, and adhere to patient-centric standards. We must align ourselves with the evolving healthcare system of tomorrow—even better, we must be the model for that system, in the lead, out in front.
Prevention and health maintenance must be the cornerstone of the new care model. It is right morally to prevent suffering; it is right fiscally, to avoid unnecessary costs. Prevention of illness and comprehensive health management is the most efficient, highest quality, and economically responsible way to promote health and avoid disease.
What, therefore, can R&D do to prevent disease? The answer is not only captured in Research and Development’s four strategic goals, as outlined in R&D’s 2009-2014 Strategic Plan, including: advancing knowledge toward improving Veterans’ health and well being; applying advances in scientific knowledge to create, test, compare and implement new treatments; attracting, training, and retaining the highest caliber staff—those of you here today; and assuring a state-of-the-art research enterprise. But it is also captured in the spirit of the researchers and innovators here today. The vision for R&D’s future is filled with opportunity and improved care for our Veterans—and the world.

On behalf of Secretary Shinseki, I commend all of you for your hard work, and for your dedication to our Veterans—today’s and tomorrow’s. I’d like to leave you with this thought: Eighty-five years from today, on the cusp of the 22nd Century, VA researchers in 2095 will look back on all you have accomplished and, I’m sure, will credit you with setting the standards of excellence that will have become their benchmarks.